Patients’ health motivates workers to wash their hands

Campaigns about hand-washing in hospitals usually try to scare doctors and nurses about personal illness. But new research suggests that this is the wrong kind of warning.

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Can changing a single word on a sign motivate doctors and nurses to wash their hands?

Campaigns about hand-washing in hospitals usually try to scare doctors and nurses about personal illness, says Adam Grant, a psychological scientist at The Wharton School, University of Pennsylvania. "Most safety messages are about personal consequences," Grant says. "They tell you to wash your hands so you don't get sick." But his new study, which will be published in an upcoming issue of Psychological Science, a journal of the Association for Psychological Science, finds that this is the wrong kind of warning.

Hand-washing is an eternal problem for hospitals. Healthcare professionals know it's the best way to prevent the spread of germs and diseases. But, on average, they only wash their hands about a third to a half of the time they come into contact with patients and germs.

Grant had done research in hospitals before, on topics like getting nurses to speak up about safety and reducing burnout among doctors. But when his first daughter was born, Grant's attention was drawn to the hospital's signs about hand-washing. "I noticed a real disconnect between what the signs were emphasizing and what I knew as a psychologist," he says.

As a psychologist, Grant knew about "the illusion of invulnerability" -- that most people think they aren't at risk of getting sick. His own research had also shown that people aren't motivated only by avoiding dangers for themselves; they also go to work because they want to protect and promote the well-being of others. The problem was, the signs warned about personal risks. These messages should fall on deaf ears among healthcare professionals, who are frequently exposed to germs but rarely get sick. "If I don't wash my hands, I'll be okay. But patients are a vulnerable group," he says.

To test that, Grant and his coauthor, David Hofmann of the University of North Carolina at Chapel Hill, came up with two signs to post over dispensers for soap and hand sanitizer. One said "Hand hygiene prevents you from catching diseases." The other said "Hand hygiene prevents patients from catching diseases." They posted these signs above different dispensers in a hospital and recorded how often people washed, measuring how much soap and gel was used― and having trained observers spy on their colleagues.

The sign about patients was the winner. Healthcare professionals were much more likely to wash their hands if they were reminded that they were keeping patients safe. The patient sign increased soap and gel use by 33% per dispenser, and healthcare professionals were 10% more likely to wash their hands. The sign about personal risks did no good.

"Our findings challenge prevailing wisdom in the healthcare professions," Grant says, "that the best way to get people to wash their hands is to scare them about their own health. Instead, his research demonstrates, you should remind them that hand-washing helps others.

A lot of interventions work well in the beginning, then drop off, and these studies only lasted two weeks. Grant suggests that future studies should test whether these signs would continue to work in the long term. It might be possible keep the message fresh by changing the signs frequently to mention different patients, or to use different slogans, like "Did you wash your hands? What if your mother was the next patient you saw?" Grant says. The punch line here is that it's not all about me. To motivate people to engage in safety behaviors, we should highlight the consequences for others―not only themselves.

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